27167 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY ONCUPERTINO RD¢BING-FIT, mCAL PERMIT No.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 27167
IIUII.UING PRO.IRC'1'11)EN'I'114CA'I'ION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
U_ >mt G GT S(g/q UNIT# LOT# D
OWNER NAME:: �S PHO liy / CONTIN J`N� �s N/C CONT OLp
,ARCH ECT'/NGINEER: ` LIC NO: ADGRE'
l,
[CON'f'ACr: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
PERMIT ISSUANCE D O Irl/ 13
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
awz I hereby affirm Thal l sm licensed underpmvisionsofChapter9(commencing with
�ilOp1 mco000)nf Oivision3of theBmirreesaM Pro(euiona Code, my liana is in ppNE1SWU{'' ullfLrce and eIT �j♦'7 ,�{{
FZW License fsr =� Lic.# // / y UP TO 2W AMPS
m-Sy Dare �/ Connor 201-1000AMPS
ZFOyR. ARCHITECTS DECLARATION OVER IOOOAMPS SQ.FT.FLOOR AREA E/SQ.FT.
O Z,., I undersand my plans shall he used as public records.
I=tnLtal SIGNS ELECTRICAL
igLicensedPofessional
OWNER-BUILDER m the Con
SPECW.CIRCUIT/MISC.
XO y V I hereby affirm that 1 am exempt from the Con ols o License Lew fm the
W 3O v[—i following reason.(Benito 7031.5,Business and Note ons Code:Any city or county TEMP.MUTER OR POLE INST.
�,M:y which requircsa pemtit to connmct,slag improv hporro sh,orrepaiganysvucture
4��-E Ile he1,liunsed puha requires Nroovis cant! suchpenNns Lice sof statement WER DEVICES
Tye<p 90amoslicerreJpumuun,to the ovi¢io the Comrutreass Licenxlatv(Chade)
mgoeL )(commencing with Ration]OOTp of D' son3af theBmin<u and Pmfasion¢Cade) B IMMING POOL ELECTRIC VALUATION
WF-_m a ulawboisucmPTtherefmmmdt usistformarillegW ennmptmn.Any vidnitn of Ol EL'S-SWITCHES-FIXTURP.S
pzG Secohn]031.56yanyapplican r a permit subjects The applicant m a civil penalty of
tarn more than live hundred ors($5 W). NE RESIDENTIALELECIR S .Ff.
x m ❑ LuownerofThepr ormyomployeeswiti.Mosssthei mlechmpemuion, Q STORIES TYPECONSTRUCION
R willdothowtok,indi svonureixnotintendedmol$e Ifornle( .7044,Busineu
and Professions Cod .The Contractor's license Law dt s t to an owner
pmpenywhobuilds improves Thereo andwhndoessud i Ifo"
ownemployecs,pmvi WThatsuch int n omen Tin an fcoed r OCC.GROUP RES.UNIT'S
howevcq,hebuildingr improvemen s r w it earofcoI nils o or 'TOTAL:
builderwillhavethelb rnofprovi ids tbuild or impAty srpurpr of
sale.). //��.
❑ I,as ownero(theprope1 mescl elyconva ti wi liauediemom m QTY. PLUMBINGPERMIT FEE FLOOD ZONE APN
construct the project(Sec.](144, i and Profe mos Code:)The C ms's PERMIT ISSUANCE
Licemc law rises a.opply Than owners- ropenywhtbuildsmimprove erenn,and 3 ve
whocontransfmsuch projens with ecnmr or(s)licensr4 pursuant eContreetors
Lacensa taw. ATER-DRAIN&VENT-WATER EAT FEE SUMMARY
❑ I am exempt under Sec. ,B P C for This remora BACK FLOW PROTECT.DEVICE UTSIDE FEES
Owner A5..
SANITARY Y N
DRAINS-FLOOR,ROOF,AREA,COND. RECEIPT'#
WORKMAN COMPENSATIO UE ARATION SCHOOLTAX Y N
❑ Dembyaffirmtha,lhaveacenificam ofa axlf-insure,m a certificate of FIXTURPS-PER TRAP RECEIPT#
Workers pension,lnsurenceoracerifiedar Thereof(S..380.Lou,C.)which PARK FEE Y N
oven all employee's under gas permit. GAS-EA.SYSTEM.]INC.4 OUTLETS RECEIPT es
Policy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Certified copy is hereby furnished.
❑ Carolled copy is filed with the city inspection division. GREASFJINDUSTRL WASTE INTERCEPT OR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not hecompleted ifthe pont is for one hundred dollars($100) SEWER-SANITARY-STORM TA.2MM', ENERGY FEE
or less.)
I certify that in thepMmmanceofthe work far which Us permitisiuuad,l shell WATER HEATER W/VENT/ELECfR
not employ any person in any manner ah m be o b' the Workers -P
§5 �t PAID
Compensation law of'ayL'fan Dae-I® a"� WATER SYSTEM/1'REATING Date Receipt p
O z Applicant ��L CCM VV IL900
0 NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ,FI', TOTAL:
F" hbecome subject to the Worker's Compensation provisions of the labor Code,you must
j
F-T forthwith comply with such Provisions or this permit shell be deemed revoked. BUILDING FEE
0. 0 CONSTRUCTION LENDING AGENCY SEISMIC FEE.
z 1 hemby affirm That hem is a comwction lending agency for the performance of
U0 The work for which This permit is issued(See.3097,Civ.C.) TOTAL: 19 ELECTRIC FEE
Lender's Name z PLUMBING FEL
0 U Undels Address QTY. M13CIIANICAL PERMIT' FEE OD
1"Airy that I have read This applicmion and mete that the above information Is
Ha correct. l a gram comply with all city shad county nNinanccs en data,.lar¢refining to PERMIT ISSUANCE MECHANICAL FEF:
n' huililm,eonsta ion,and here tathori.repreacnativesafthm city memeruamin.
[) Z uMvc-me)sameproperty
save. for impaction purposes. ALTER OR ADD TO MECIi.
CONST'RUCT'ION TAX
(We)agree nt save,indemnify and keep may in
the City of Camino id inst —
City
iahili,ics,judgmeme,costs and ex penspewhich may in any way acemcegninst said City AIR HANDLING UNIT(TO 10.000 CPM)
1Lnce of tll^umting of this permit.
ns. AIR HANDLING UNIT(OVER LB00 CFM1
_L }pJ l
Sigrumrc of ApplicuMCtmmear Carl EXHAUST HOOD(W/DUCD
PAID
HAZARDOUS MATERIALSinWcu DISCLOSURErhand
HEATING UNIT(TO IW,(Plfl BTU) Date Receipt#
Will the the Cuantorlmuicipal Code,Cadeint r9.ore o,handle Health and
HEATING UNIT(OVER IW,(I00 BTI!) TOTAL:
as Defined by the Copcnino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)7 VEN'f11A1'ION PAN(SINGLE RESID)
❑Yes ❑No
Will the applicant hrfinumbuilding occupant useegnipmentordeviceswhichetniT
BOILER-COMP(311P OR 100.00l eTV),00ISSUANCE DATE
hazardous air contaminants as defined by the Buy Area Air Quality Management BOILER 100,0(10 BTU)
District' OCT 14 1994
❑Yer 11 No NEW RESIDENTIAL MLCH. SQ.FT.
1 Tuve read the hazardous materials tequitemems under Chapter 6.95 of the
Culiromin lleallh&Safety Cale,Sections 25505,25533 and 25534. 1 understand that L(( 1 LII kes.f Cru tlVU
if the building docs not currently have a amount.that it is my responsibility to notify the
cupant of the requirements which as,be met prior to is.uance of u Cenifsme of
occupancy.
Owner or authorized agent Data OFFICE
IA TOTAL: ISSUED BY: I v
Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
September 26, 1995
Yau
22633 Woodridge,
Cupertino, CA 95014
Subject:22633 Woodrige, Permit# 27167
Dear Sir,
According to our records the above mentioned permit has never been finaled by a
City Building Inspector. A permit is considered to be valid only six months from its
last,nspection date. If your permit shows that the final inspection has been completed
please send a copy of the permit, along with this letter to 10300 Torre Avenue,
Cupertino, CA., 95014, Attention Building Department.
If your permit has not been finaled, please contact the Building Department by
calling (408) 777-3228, so that we may arrange to extend your permit, and schedule a
final inspection.
In an effort to control the number of expired permits, the City of Cupertino
requires a response in ten working days from your day of receipt of this letter. If we do
not hear from you, the City of Cupertino's Building Department will have no
alternative but to resolve your permit as expired and discard the records.
Thank you for your assistance.
Sincerely,
City of Cupertino
Pnmdn on Reap;r„',yd P,nef